Hospital E/M question
When our providers see a patient in the hospital sometimes the patient is listed as outpatient with observation service. We trying to figure out if we use the outpatient codes (99201-99215) or do we use the observation code (99218-99220) for the e/m. Any ideas?
Comments
Laurie Johnson
Laurie Johnson, CCS, COC
Certified Coder
Hannibal Regional Healthcare System
573-248-5421 (O)
Laurie.johnson@hrhonline.org
CPT GUIDELINES:
“New or Established Patient Initial Hospital Observation Care Services
The following codes are used to report the encounter(s) by the supervising physician or other qualified health care professional with the patient when designated as "observation status." This refers to the initiation of observation status, supervision of the care plan for observation and performance of periodic reassessments. For observation encounters by other physicians, see office or other outpatient consultation codes (99241-99245) or subsequent observation care codes (99224-99226) as appropriate."
See CMS CPM Chapter 12. 30.6.8 section A:
For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial and subsequent observation care codes. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.
Jennifer Cossin
Billing Manager
Central Ohio Surgical Associates, Inc.
(614) 866-4270
(614) 866-4271 (fax)
jcossin@cosadocs.com
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We are getting these too. We are appealing, with a letter stating different taxonomy codes, different practices, and different specialties.
Thanks
Deborah Broyles, CPC
Supervisor/Coding Specialist
University Radiation Oncology/University Surgical Oncology
865-305-9886 phone / 865-305-9714 Fax
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Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
Main: 513-771-7070
Direct: 513-672-4363
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200 Northland Blvd
Cincinnati, OH 45246
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Here's the dealio:
When the Subsequent Observation Care codes were released, CPT said that they could be used in much the same way as Subsequent (Inpatient) Hospital Care codes were, in that they were to be used primarily by the admitting specialty for care occurring between the day of admission and the day of discharge—true—but were also available for use by other specialties seeing the admitted patient during any day of their stay when a consult code did not apply. For CPT, only the Initial Care and Discharge code categories were restricted for use only by the admitting/attending specialty.
Medicare, in their never-ending desire to be different, took a more restrictive stance for the new Subsequent Observation Care codes, and said that only the admitting/attending specialties could use the subsequent visit codes from this particular category and that other specialties seeing the patient should bill for observation care using the Outpatient Office Visit codes.
Some Medicare managed care plans followed Medicare's lead, while almost every commercial insurer that I know of follows CPT's direction. So everybody is right, depending on the payer.
Seth